What the GMC can’t do
The GMC cannot:
• deal with concerns or complaints about nurses, pharmacists, dentists, opticians, hospital or practice managers or administrative staff, or anyone who is not a registered doctor;
• normally give you a detailed explanation of what happened to you. This can only come from the doctor or health provider;
• order a doctor to provide the treatment you want;
• pay you compensation;
• fine a doctor;
• order a doctor to give you access to your records;
• make a doctor apologise to you.

An independent report cleared the GMC of racial bias in 2000 despite finding 50% of doctors struck off in 1999 were from overseas qualification whereas only 38% were UK qualified. While the overall number of complaints received about overseas-qualified doctors was roughly representative of the group as a proportion of the medical profession (about 27%-29%), the number of cases, which were then referred up to the Fitness to Practice Panel, was extremely disproportionate. The study found this bias “impossible to explain”. Several excuses were put forward for this anomaly – doctors working in pressure areas, locums, high-risk specialties and even the influx of doctors from the commonwealth in the fifties and sixties when the regulation was not as strict as it is now. Concern has also resulted from several studies, which have shown that GMC handling of complaints appear to differ depending on race or “overseas qualification”.

Mortality among doctors referred to FTP:

In a response to a request for information using the Freedom of Information Act, the GMC revealed that 68 doctors had died during FTP proceedings. The mortality and morbidity amongst doctors going through these procedures is one of the highest of any profession going through similar investigation. In 2003/4 between 4 and 5% of doctors undergoing fitness to practice scrutiny died.

We already spend up to £1bn regulating doctors. We are one of the most over-regulated professions around and there will always be people who fall through. If we pile on more and more regulation, we will never win.

The GMC has now released this new guide to sanctions, which goes a long way to make it draconian to say the least. There is nothing in the document to safe guard doctors against incompetent assessment. We have seen that any doctor referred to the FTP is more often than not treated as guilty unless proven otherwise. In a court of law, the accused is treated as innocent until proven guilty. I would not be surprised if the statistics of deaths and morbidity among doctors referred to the FTP will increase due to the new sanctions guide.

Changes to our sanctions guidance

Reviewing how we deal with concerns about doctors:

A public consultation on changes to our sanctions guidance and on the role of apologies and warnings

Our proposed changes guide panels to:

Take appropriate action to protect the public interest without being influenced by the personal consequences for the doctor.

Take action in all cases where a doctor’s fitness to practise is impaired, unless there are exceptional circumstances which meet a specific definition.

Take appropriate action to maintain public confidence in doctors even when a doctor has remediated.

Consider more serious action where cases involve a failure to raise concerns, failure to work collaboratively, discrimination or abuse of professional position involving predatory behaviour.

Consider the factors that may lead to more serious action where specific issues arise in a doctor’s personal life, which undermine confidence in doctors (e.g. criminal or civil proceedings).

Consider specific aggravating and mitigating factors when deciding on the action to take in cases involving addiction or misuse of alcohol or drugs.

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Just when the General Medical Council is considering more serious sanctions against doctors, this hits headlines. Doctors like this (BMJ2014;349:g5236) are the cause for the council to get tougher on rogue doctors. But, they bring not only shame on the rest of the medical fraternity, but also push most of us to practice defensive medicine to the detriment of our patients.

Dr Krishnamurthy Nulliah, a cosmetic surgeon at Harley Street, has been struck off from the register for using his skill to earn money rather than treat people. He has been found guilty of “subordinating his proper responsibilities as a doctor to the pursuit of a commercial enterprise.” He was running his practice as a vendor and corner shop merchant offering discounts to patients. “BOGOF” was an everyday practice for him, according to the MPTS panel. He was found to have offered discounts to one patient if she agreed to treatment in additional areas. Mind boggles at this doctors audacity.

While we cannot comment on the veracity of the claims by both sides, it is difficult to understand how a doctor could completely ignore the Hippocratic oath and deal with patients as commodities. We have seen how such panels work and come to their decisions, often to the detriment of the practitioner. The process starts off with an investigative team statement saying that they are not there to investigate the matter. They never ask the complainant to show evidence or proof of their allegations. Everything is taken as hearsay, and if it is not written down, it did not happen. I suspect, if this doctor had written down that he had taken proper consent and discussed the issues with the patients, he might have got off.

Unfortunately there are rogue doctors in our fraternity who do behave the way the MPTS panels state and they are the cause of increasing threats from the governing body. This will only lead to further inward looking practices and may even cause a stagnation in medical practice. Innovation will not be considered by anyone for the fear of “getting wrong with the GMC.”

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The dreaded GMC led “Fitness to Practice Panel” has died. Long live Medical Practitioners Tribunal Service (MPTS). It is headed by a highly respected Judge, Sir His Honour David Pearl. It can only mean good news for the medical fraternity as a whole. The very fact that it is headed by a highly respected Judge who until recently, the President of The Immigration Appeal Tribunal and President of the Care Standards Tribunal is a welcome change. He is also the author of “Care Standard Legislation Handbook” and should have a very good handle on a day to day working of the Health care in this country.

The aims of the new organisation are laudable – “Aim is to enhance the confidence of doctors, professional bodies and patients in the impartiality, effectiveness and transparency of the GMC’s adjudication function.” All these qualities hopefully make stories as portrayed in “A Kangaroo Court: A Triumph of Mediocrity” a thing of the past. Does the statement mean that the organisation has finally accepted that these qualities were missing?

The blurb on the website says – “One of the early priorities for the MPTS is to make improvements to the way that panellists are trained and performance managed. This will lead to higher quality decision making”. There does not seem to be much change in this statement from before. All the panellists and assessors in the old GMC led FTP panels were supposed to be “fully trained”.

There was always a question of “accountability” before for their actions. Now the MPTS and its officers are answerable to the Parliament. Another major move from before is the separation of GMC as the Investigator and Prosecutor and the MPTS will function as the Judge. This is the first time in the history of General medical Council that the Prosecutor and Judge have been separated.

His Honour David Pearl has been quoted as saying ‘As incoming Chair, I want to make certain from the very start that decisions made by the MPTS are impartial, proportionate and evidence-based; that the MPTS enhances patient safety and that we increase the confidence in the adjudication process itself among doctors and the public.’ The point of note here is “Evidence based”. In the past hearings, evidence was never really sought and statements from individuals were taken as gospel truth (read ‘A Kangaroo Court: a Triumph of Mediocrity’).

Council for Health Care Regulatory Excellence (CHRE) was involved from the beginning in consultation during setting up of the MPTS. The CHRE was quite clear on the issues of Panellists training, which included regular appraisal of panellists. Hopefully this will clear some of the dead wood that populates team now. The CHRE also insisted on accountability and transparency in the dealings between MPTS and the GMC. There is still a question of presence of Legal Assessors and the Chair of the panels. It is not very clear as to whether there would be any move away from the past practice of GMC appointed legal assessor and a Chair.

Other major reforms include:

The introduction of digital recording of hearings.

Enabling panel chairs to be involved in pre-hearing case management.

The introduction of a power to make costs orders in cases where either the registrant or the GMC has been unreasonable in the conduct of proceedings.

The introduction of legally qualified chairs.

While all the information that is coming out in the news about the newly launched MPTS makes positive reading and may go a long way in increasing the confidence of the medical profession, its website itself does look remarkably similar to the old GMC. So, I wonder if we are entering into a new era of transparency and high quality impartial decisions or if it is just old wine in a new bottle. Only time will tell. Watch this space.